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Abstract
The article discusses the provisions for identifying guidelines with the identification of the association for the study of the liver (European Association for the Study of the Liver, EASL) and the American Association for the Study of Serious Liver Diseases (American Association for the Study of Liver Diseases, AASLD) for the immediate detection of drug-induced disease (DILI). Data on the etiology, exclusions, and isolation of DILI, methods of diagnosis, examination, and management of patients with DILI, both with the use of pharmacological therapy and liver transplantation, are presented.
A clinical case of multiple lesions of the liver, kidneys, and pancreas is presented against the background of long-term use of a combined drug containing acetaminophen and metamizole. The calculation of the RUCAM score confirmed that acetaminophen could be the etiological factor in chronic DILI in this case. According to the EASL recommendations, the type of DILI was determined in AASLD — a cholestatic type of lesion was stated. The presence of concomitant kidney damage in the form of chronic kidney disease, drug-induced interstitial nephritis, hepatorenal syndrome, and uremia had a great influence on the possibilities of pharmacological correction of DILI. Presumably, the long-term toxic effects of acetaminophen led to the development of pancreatic steatosis, followed by degeneration into non-alcoholic fatty pancreatic disease with the development of moderate exocrine organ insufficiency. Recommended drugs that help resolve intrahepatic cholestasis (Heptral®, Bicyclol), pancreatic (Creon®), and renal failure, the issue of prescribing corticosteroids is being resolved. A feature of this clinical case is the development of subclinical drug-induced primary biliary cholangitis (AMA-M2 were detected).
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